Quick viewing(Text Mode)

MORPHOLOGICAL CLASSIFICATION and PARAMETERS of SPINE of SCAPULA AMONG SOUTH INDIAN POPULATION Mamatha Y 1, Swaroop N *2, Jagadish 3

MORPHOLOGICAL CLASSIFICATION and PARAMETERS of SPINE of SCAPULA AMONG SOUTH INDIAN POPULATION Mamatha Y 1, Swaroop N *2, Jagadish 3

International Journal of Anatomy and Research, Int J Anat Res 2019, Vol 7(3.3):6906-10. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2019.253 MORPHOLOGICAL CLASSIFICATION AND PARAMETERS OF SPINE OF AMONG SOUTH INDIAN POPULATION Mamatha Y 1, Swaroop N *2, Jagadish 3. Associate Professor, Department of Anatomy, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India. Assistant Professor, Department of Anatomy, Kodagu Institute of Medical Sciences , Madikeri, Karnataka, India. Statistician, Department of Community Medicine, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India. ABSTRACT

Introduction: Scapula is a pivotal of girdle, critical in stabilizing and permitting various sports movements like swimming, rowing and throwing. Isolated fractures of the scapular spine are rare. Usually, they are associated with other fractures of the or injuries to the head, lungs, ribs, cervical spine and brachial neurovascular structures constituting 6% of scapular fractures. Objectives: 1) to classify and to obtain the Quantitative morphometric parameters of scapular spine and also to find the asymmetry of the same bilaterally. Methodology: This study was conducted on 100 dried adult Human Scapula. were observed and classified morphologically, various morphometric measurements like projection length of spine, thickness and height of spine of scapula were taken using digital vernier caliper and thickness measuring gauge micrometer. The data was analysed statistically using SPSS software version 20.0 and were tabulated. Results: The commenest type of spine was fusiform (type I) with 46% and the least was “S” shape type V with 0% incidence. Type II (slender) spine showed least measured values related to all the parameters. Conclusion: Spine of scapula is an important process, provides elegant reinforcement to dorsal surface of scapula. A morphological variation of the same is not a rare entity in our observation. With recent development in surgical approaches towards the clinical conditions of thorough qualitative and quantitative knowledge of the same is necessary for any surgeon which can be an additional aid for the surgeon during surgeries. KEY WORDS: Spine, Scapula, Classification, Fracture, Morphology. Address for Correspondence: Dr Swaroop N, Assistant Professor, Department of Anatomy, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India. Pin Code: 571201 Phone No: 9611886540.E-Mail: [email protected] Access this Article online Journal Information Quick Response code International Journal of Anatomy and Research ICV for 2016 ISSN (E) 2321-4287 | ISSN (P) 2321-8967 90.30 https://www.ijmhr.org/ijar.htm DOI-Prefix: https://dx.doi.org/10.16965/ijar Article Information Received: 15 Jun 2019 Accepted: 05 Aug 2019 Peer Review: 17 Jun 2019 Published (O): 05 Sep 2019 DOI: 10.16965/ijar.2019.253 Revised: None Published (P): 05 Sep 2019

INTRODUCTION 6 % of scapular fractures are scapular spine Scapular bone fractures are rare injuries which fractures. Fractures of scapular body may cause constitutes of 1 % of all the fractures and 5 % of a weak function and loss of an shoulder girdle fractures. Most of the scapular active elevation, named ‘pseudo-rupture’ of fractures involve the neck and body, and only the rotator cuff, probably due to inhibition of

Int J Anat Res 2019, 7(3.3):6906-10. ISSN 2321-4287 6906 Mamatha Y, et al., MORPHOLOGICAL CLASSIFICATION AND PARAMETERS OF SPINE OF SCAPULA AMONG SOUTH INDIAN POPULATION. the muscle contractions from intramuscular osteologic features. haemorrhage. Also, pseudo-arthrosis of spine of · To evaluate the asymmetry of parameters scapula or , like os acromiale, predis- bilaterally poses to sub-acromial impingement syndrome. METHODOLOGY The pull of the can tilt the frag- ment inferiorly, which compromises the function The present study was done on one hundred of the rotator cuff. Sagging of the lateral spine (100) dry an adult human scapula. Age and sex projection over acromion effectively produces of the donors were unknown. Types of scapula narrowing of the supraspinatus outlet and were classified into following five types secondary impingement of the rotator cuff [1]. morphologically, Type 1- Fusiform shape (tapered at both ends and wide in the middle), Type 2- As Lambert et al. states in their study, fracture Slender rod shape (thin throughout), Type 3- of scapular spine represents a partial failure of Thick rod shape (thick throughout), Type 4- the lateral scapular suspension system, Wooden club shape(gradual thickening from leading for failure of scapular postural control, medial to lateral edge), Type 5- Horizontal with resulting sub-acromial impingement result- S-shape (“S” shaped spine) . Nine bony land- ant impingement syndromes of the shoulder. marks described for their relevance to regions Although scapular spine fractures are rarely of interest for scapular fixation were chosen and seen, they must be considered in differential marked (Fig 1, 2).Measurements were taking diagnosis of impingement syndromes of the using digital vernier caliper and thickness of shoulder [2]. spine was taken using thickness measuring How the trabecular bone density varies within guage digital micrometer. the scapula and how can this may lead to more • AE (superior border of SS): length of SS mea- optimal Reverse Shoulder Arthroplasty (RSA) sured from the medial edge of the scapula where screw placement has not been addressed in the it meets with the SS to the lateral midpoint of scientific literature. The three columns of tra- lateral edge of the acromion. becular bone runs within the scapula adjacent to the , one extending through the • AD: length of SS measured from the medial base of the , a second along edge of the scapula where it meets with the SS the lateral border, and a third extending into the to the corner of the acromion. spine of scapula, were hypothesized to be of • AC (base border of SS): distance from the similar density relatively. The base of the cora- medial edge of the scapula where it meets with coid process was statistically significantly less the SS to the edge of the spinoglenoid notch. dense than the spine and the lateral border of • BC (lateral border of SS): height of the spine the scapulae examined (P < 0.5). The higher- at the lateral edge. quality bone component in the lateral border • FG and HI: Height of the spine at point G and I. and spine, compared with the coracoid region, • J, K, L: midpoints of FG, HI, and BC. may provide better bone plate for screws when fixing the glenoid baseplate in RSA. AS the stud- ies done related to morphological and morpho- metric parameters of spine of Scapula is quite rare though the variations is quite common, the present study was done to add into the data of spine of scapula which may be helpful for orthopedicians [3]. Objectives: Fig. 1: Fig. 2: · The objective of this study was to classify the Statistical data: All data observed are presented SS (scapular spine) morphologically as Mean and standard deviation (SD). Descrip- · To provide baseline data of specific geometri- tive statistics was used to describe demograph- cal parameters of scapular spine according to ics and measurement variables of all scapulae.

Int J Anat Res 2019, 7(3.3):6906-10. ISSN 2321-4287 6907 Mamatha Y, et al., MORPHOLOGICAL CLASSIFICATION AND PARAMETERS OF SPINE OF SCAPULA AMONG SOUTH INDIAN POPULATION.

Categorical variables are expressed as frequen- Fig. 3: Showing different types of Spine of Scapula. cies and percentages. Unpaired “t” test was used to compare types considering a P-value < 0.05 as statistically significant. The Statistical Pack- age for Social Sciences (SPSS version 20.0) was used for the analysis of the data. RESULTS In the present study, the commonest type of spine was fusiform (type I) with 38%, second Type I: fusiform Type II: slender being the type IV with 28% followed by type III with 24%, Type II with 10% and the least was “S” shape type V with 0% incidence, not much of the difference observed bilaterally (Table 1). Table 1: Showing percentage of morphological different types of spine of Scapula.

TYPE Out of 100 Based on side N (%) Right(50) 19(38) I 35 Left(50) 16(32) Type III: thick rod shape Type IV: Wooden club shape Right(50) 05(10) II 16 32.8±6.7mm respectively.. A complete descrip- Left(50) 11(22) tion and summary of the results can be observed Right(50) 12(24) III 21 in Table 2. No significant difference was found Left(50) 09(18) between left and right scapulae. A summary of Right(50) 14(28) IV 28 the thickness for the bony landmarks on the SS Left(50) 14(28 is shown in (table 3). “L’’ representing thick- V NIL NIL NIL ness at midpoint of BC being the thickest in all The average length of AE, AD, AC and BC on types , Type II was the thinnest and shed least right and left side were 140.6 ± 10.1 to 115.7± values. Overall, Type 1, 3, 4 showed thicker val- 3.3 mm, 124.4 ±7.5 to 107.7± 4.14, 88.6± 7.0 to ues . No statistical difference was found between 69.66 ± 4.8mmand 44.1± 4.5 to 32.8± 6.7mm , left and right sides of the body. p value>0.05 127.9±7.4 to 123.0± 9.8mm, 120.5±7.5 to 114.7± was not statistically significant. 10.7mm, 82.9±11.6 to 78.9±7.4mm , 38.0±6.9 to Table 2: Distribution and Measurements of the Scapular Spine based on Sides among different types of scapula. AE AD AC BC FG HI TYPES SIDE N (%) Mean±SD Mean±SD Mean±SD Mean±SD Mean±SD Mean±SD RIGHT(50) 19(38) 127.8(8.4) 121.9(7.7) 80.5(4.3) 39.5(4.2) 25.0(2.8) 30.2(3.7) TYPE 1 LEFT(50) 16(32) 127.9(7.4) 120.5(7.5) 82.7(5.4) 37.4(7.2) 23.9(2.8) 24.3(2.3) RIGHT(50) 05(10) 115.7(3.3) 107.7(4.14) 69.66(4.8) 36.1(2.3) 26.24(3.3) 28.86(2.2) TYPE II LEFT(50) 11(22) 124.7(12.2) 114.7(10.7) 78.9(7.4) 38.0(6.9) 22.3(2.7) 24.6(2.7) RIGHT(50) 12(24) 140.6(10.1) 124.4(7.5) 88.6(7.0) 44.1(4.5) 26.2(6.2) 28.6(3.3) TYPE III LEFT(50) 09(18) 126.1(13.9) 119.8(14.9) 82.9(11.6) 37.9(7.4) 23.1(2.9) 24.6(4.3) RIGHT(50) 14(28) 120(8.1) 116.7(8.0) 71.1(6.4) 39.9(4.4) 27.6(3.0) 33.5(4.2) TYPE IV LEFT(50) 14(28) 123.0(9.8) 115.0(11.2) 79.6(7.3) 32.8(6.7) 22.8(1.9) 23.4(2.9) RIGHT(50) 0 ------TYPE V LEFT(50) 0 ------

Int J Anat Res 2019, 7(3.3):6906-10. ISSN 2321-4287 6908 Mamatha Y, et al., MORPHOLOGICAL CLASSIFICATION AND PARAMETERS OF SPINE OF SCAPULA AMONG SOUTH INDIAN POPULATION. scapular body or acromion. Those fractures that DISCUSSION enter the spino-glenoid notch are clearly Over the past decade, there has been an in- different from isolated acromial fractures and creased interest in understanding the operative therefore should be identified and treated indications and techniques in treating scapular differently [7]. fractures and tracking their outcomes. Multiple Scapular spine fractures, especially those at the studies done over decades have documented base of the acromion, are uncommon. Further- poor functional outcomes following non-opera- more, the complex bony anatomy of the scapula tive management of displaced scapular sometimes makes accurate classification of fractures. There is a groundswell of recognition fractures on a plain radiograph rather difficult, that severe deformity from scapular fractures thus justifying the need to use CT scanning.The malunion is strongly associated with poor use of three-dimensional reconstructed CT functional consequences among patients. This images in the current case provided essential has lead to a growing recognition that scapular and accurate preoperative information about the fractures should also be held to the same stan- position and extent of the fracture, thus facili- dards as other bodily fractures with regard to tating preoperative planning [8]. fracture fixation principles, including anatomic Based on morphological classifications, Hua Jun articular reduction, proper alignment, and stable Wang states that Type 1-Fusiform shape internal fixation. Through research, there has (47.17%) and Type 5-Horizontal S-shape been an improved understanding in patterns of (19.18%) were the most common, followed Type scapular fracture and the relevant surgical 4-Wooden club shape (13.21%) and Type 3-Thick approaches used for fracture fixation [4]. rod shape (12.58%). Type 2-Slender -rod shape According to Mohammed AS Sultany reports in (7.86%) was the least common [9]. his study, Scapular fractures are relatively In our study the Type 5-S Shape (0%) was the uncommon and generally represent 0.5–1% of least common, commonest being type 1-fusi- all fractures. Of these, fractures of the body and form(35%), followed by type IV (28%) and type neck are the most common and account for more III(21%). The average length of landmarks AE, than two-thirds of the cases, with intra-articu- AC, and BC of the SS were 135.83 ± 10.33 mm, lar fractures of the glenoid cavity (rim and fossa) 83.27 ± 6.22 mm, and 45.60 ± 5.45 mm, respec- making up approximately 10%. Fractures of the tively, In our study it was observed that AE acromial and coracoid processes account for 9% ranged from 140.6± 10.1 -115.7±3.3mm, and 7%, respectively, while those of the scapu- highest projection length of the scapula being lar spine only represent about 6% [5]. of type III and least of Type II which is almost In a study done to measure and map scapula correlating with the previous studies done by osseous thickness to identify the optimal areas authors. In a study on Six patients with grade for internal fixation, the glenoid fossa (25 mm) III mandibular ORN who were treated with displayed the greatest mean osseous thickness, debridement of lesions, Type IIb soft tissue and followed by the lateral scapular border (9.7 mm), type H hemimandible defects after surgery were the scapula spine (8.3 mm), and the central reconstructed using bilobed myocu- portion of the body of the scapula (3.0 mm). To taneous flaps and scapula osteomyocutaneous optimize the screw purchase and strength of flaps including the acromion, spine, and part internal fixation, the lateral border, the lateral of the medial scapular border based on the aspect of the base of the scapula spine, and the transverse cervical vessels showed satisfacto- scapula spine itself should be preferred rily results without any complications. Thus anatomic sites of internal fixation of scapula scapula osteomyocutaneous flap based on fractures [6]. transverse cervical vessels may be an effective We are currently unaware of any major studies approach to reconstruct through-and-through that have specifically focused upon scapular defects of the hemimandible and to provide spine fractures, possibly because such fractures satisfactory or acceptable functional and es- are frequently grouped with fractures of the thetic outcomes after debridement of advanced Int J Anat Res 2019, 7(3.3):6906-10. ISSN 2321-4287 6909 Mamatha Y, et al., MORPHOLOGICAL CLASSIFICATION AND PARAMETERS OF SPINE OF SCAPULA AMONG SOUTH INDIAN POPULATION. mandibular ORN [10]. outcome. Thus this study may serve as baseline The most detailed description of the use of the data for the same. scapular spine pedicled on trapezius is given by ACKNOWLEDGEMENTS Panje and Cutting (1980) in their description of a case history that involved resection of the body I would like thank our head f the Institution, of a hemimandible in a jaw previously irradiated Ethical and Scentific committe for making this for epidermoid carcinoma. Kenyeres (1984) used study possible. I hereby would like to convey my the medial part of the scapular spine for recon- heartfelt thanks to all my dear colleagues and struction of the maxilla because of the close also non teaching staff of our department for morphological similarity of this buttressed part their support throughout this study. of the spine to flat bone. We feel that scapular Conflicts of Interests: None spine , split sternum pectoralis major osteomu- sculocutaneous pedicled to trapezius is a REFERENCES valuable addition to the transfer, where previ- [1]. Cem Copuroglu, ,Levent Tan, Elif Copuroglu, Mert ous radiotherapy has made the area relatively Ciftdemir, and Mert Ozcan. Pseudo-arthrosis of the avascular or where previous unsuccessful recon- spine of the scapula: a case report with a delayed struction requires an alternative approach [11]. diagnosis. Strategies Trauma Limb Reconstr. 2014 Nov; 9(3): 173–177. CONCLUSION [2]. Lambert S, Kellam JF, Jaeger M, et al. Focussed classification of scapula fractures: failure of the In conclusion, the present study classified and lateral scapula suspension system. Injury. 2013;44: measured SS morphology on 100 dry adult 1507–1513. a human scapula. Type 1 was the most common, [3]. Matt A.DaalderMSc .Trabecular bone density dis- tribution in the scapula relevant to reverse shoul- while Type 5 was the least common. The der arthroplasty. JSES Open Access.Volume 2, Issue contours of Types 5 and 1 were more complex 3, October 2018, Pages 174-181. than the other 3 types. Types 2 were much [4]. Peter A. Cole, Gil Freeman, and Jonathan R. thinner than the other types; therefore, we Dubin.Scapular Fractres.Curr Rev Musculoskelet believe this type to be more prone to fracture. Med. 2013 Mar; 6(1): 79–87 [5]. Mohammed As-Sultany, Amol Tambe, David I. Clark The presented data provides precise and . Nonunion of a scapular spine fracture: Case re- well-sorted information about SS variation and port and management with open reduction, inter- localization in South Indian population. This data nal fixation, and bone graft. Int J Shoulder Surg. supplements existing reports which contribute 2008 Jul-Sep; 2(3): 64–67. 10.16965/ijar.2019.253 to a thorough understanding of the human SS. [6]. Charity S. Burke. Scapular thickness—implications

for fracture fixation, September–October, 2006 Vol- DOI: With advancement in surgical approaches ume 15, Issue 5, Pages 645–648. towards shoulder arthopathies and scapular [7]. Nissen CW. The acromion: Fractures and Os spine fractures it becomes important to have acromiale. Oper Tech Sports Med.2004;12: 32–4. thorough prior knowledge of morphological and [8]. Goss TP. The scapula: Coracoid, acromial and avul- morphometric parameters of SS. Reduce in sion fractures. Am J Orthop.1996; 25:106–15. [9]. Hua-Jun Wang.Classification and Morphological surgery time, additional aid for the surgeon, Parameters of the Scapular Spine-Implications for decrease the future complications like malunion, Surgery.2015 Nov; 94(45): e1986. tissue irritation. Recently scapular spine is [10]. Chen WL, Wang Y, Zhou B, Chen R. Ann Plast Surg.

Using a Bilobed Trapezius Myocutaneous Flap and INDIAN SOUTH AMONG SCAPULA OF SPINE PARAMETERSOF AND CLASSIFICATION Y, MORPHOLOGICAL Mamatha Jagadish. N, Swaroop

proving as an alternate option as osteo- : myocutaneous flap but an optimal osteo- Scapula Osteomyocutaneous Flap to Reconstruct Through-and-Through Defects of the Hemimandible myocutaneous flap needs to be long and strong After Debridement of Advanced Mandibular Osteo- for bony union, and contoured to be able to radionecrosis. Ann Plast Surg. 2018 Nov; 81(5):548- reconstruct complex 3-dimensional skeletal 552. defects. Estimating availability of bone as well [11]. C. Bem and P. M. O’Hare. Case report: reconstruc- as familiarizing with morphological features of tion of the mandible using the scapular spine pedicled upon trapezius muscle; description of the How to cite this article this cite to How 2019;7(3.3):6906-6910. Res Anat J Int POPULATION. the scapular spine is very essential for an posterior approach to the transverse cervical ves- appropriate contouring and fitting of the bone sels. British Journal of Plastic Surgerv.1986; 39, 473- graft to the defects to ensure the best functional 477.

Int J Anat Res 2019, 7(3.3):6906-10. ISSN 2321-4287 6910

Top View